Myocardial inflammation is an important cause of cardiovascular morbidity and sudden cardiac death in athletes. The relationship between sports practice and myocardial inflammation is complex, and recent data from studies concerning cardiac magnetic resonance imaging and endomyocardial biopsy have substantially added to our understanding of the challenges encountered in the comprehensive care of athletes with myocarditis or inflammatory cardiomyopathy (ICM). In this review, we provide an overview of the current knowledge on the epidemiology, pathophysiology, diagnosis, and treatment of myocarditis, ICM, and myopericarditis/perimyocarditis in athletes, with a special emphasis on arrhythmias, patient-tailored therapies, and sports eligibility issues.

The prediction and prevention of sudden cardiac death is the philosopher’s stone of clinical cardiac electrophysiology. Sports can act as triggers of fatal arrhythmias and therefore it is essential to promptly frame the athlete at risk and to carefully evaluate the suitability for both competitive and recreational sports activity. A history of syncope or palpitations, the presence of premature ventricular complexes or more complex arrhythmias, a reduced left ventricular systolic function, or the presence of known or familiar heart disease should prompt a thorough evaluation with second level examinations. In this regard, cardiac magnetic resonance and electrophysiological study play important roles in the diagnostic work-up. The role of genetics is increasing both in cardiomyopathies and in channelopathies, and a careful evaluation must be focused on genotype positive/phenotype negative subjects. In addition to being a trigger for fatal arrhythmias in certain cardiomyopathies, sports also play a role in the progression of the disease itself, especially in the case arrhythmogenic right ventricular cardiomyopathy. In this paper, we review the latest European guidelines on sport cardiology in patients with cardiovascular diseases, focusing on arrhythmic risk stratification and the management of cardiomyopathies and channelopathies.

Background/Objectives: Implantable loop recorders (ILRs) are widely used for the diagnosis of unexplained syncope, palpitations, and cryptogenic stroke. While ILRs demonstrate clinical utility, data on their diagnostic yield and value in real-world settings remain limited. This study evaluates ILR performance, diagnostic yield, and clinical impact across multiple indications. Methods: We retrospectively analyzed 316 patients who underwent ILR implantation between 2017 and 2023 at a single center. Indications included unexplained syncope, palpitations, and atrial fibrillation (AF) detection. Diagnostic yield, defined as the ratio of positive diagnoses to implants, and diagnostic value, defined as diagnoses leading to therapeutic changes, were assessed. Diagnostic appropriateness, reflecting diagnoses consistent with implant indications, was also investigated. Continuous variables were analyzed using an independent samples t-test or ANOVA, when appropriate; dichotomous variables were analyzed using a chi-square test. Results: The overall diagnostic yield was 30%, with most diagnoses occurring within 24 months post-implantation. Bradyarrhythmias were diagnosed earlier (mean: 290 days) than tachyarrhythmias (590 days, p = 0.04). The diagnostic value was 29%, and the appropriateness reached 70%. The diagnostic-value-to-diagnostic-yield ratio was shown to be as high as 97%, suggesting that whenever a diagnosis was made, it was of clinical impact. Patients with presyncope showed a higher diagnostic yield, particularly for tachyarrhythmias. Device re-implantation showed limited utility, as only one diagnosis (classified as bystander) was achieved in 32 re-implanted patients. After 900 days, the diagnostic yield decreased significantly, with the number needed to follow (NNF) rising from 3.85 to 18 (p < 0.001). Conclusions: ILRs are effective for arrhythmia detection, demonstrating significant diagnostic and therapeutic impact, particularly within the first two years. The recurrence of presyncope and atrial dilation was associated with higher yields, while isolated syncope posed diagnostic challenges. Prolonged monitoring beyond 900 days and device re-implantation provided diminishing returns.

Introduction: Transcatheter atrial fibrillation (AF) ablation is still carried out with continuous invasive radial arterial blood pressure (IBP) monitoring in many centers. Continuous noninvasive blood pressure (CNBP) measurement using the volume-clamp method is a noninvasive alternative method used in ICU. No data on CNBP reliability are available in the electrophysiology lab during AF ablation, where rhythm variations are common. Background: The objective of the present study was to compare continuous noninvasive arterial pressure measured with the ClearSight device (Edwards Lifesciences, Irvine, CA, USA) with invasive radial artery pressure used as the reference method during AF ablation. Methods: We prospectively enrolled 55 consecutive patients (age 62 ± 11 years, 80% male) undergoing transcatheter AF ablation (62% paroxysmal, 38% persistent) at our center. Standard of care IBP monitoring via a radial cannula and a contralateral noninvasive finger volume-clamp CNBP measurement device were positioned simultaneously in all patients for the entire procedure. Bland-Altman analysis was used to analyze the agreement between the two techniques. Results: A total of 1219 paired measurements for systolic, diastolic, and mean arterial pressure were obtained in 55 subjects, with a mean (SD) of 22 (9) measurements per patient. The mean bias (SD) was −12.97 (13.89) mmHg for systolic pressure (level of agreement −14.24–40.20; correlation coefficient 0.84), −1.85 (8.52) mmHg for diastolic pressure (level of agreement −18.54–14.84; correlation coefficient 0.77) and 2.31 (8.75) mmHg for mean pressure (level of agreement −14.84–19.46; correlation coefficient 0.85). Conclusion: In patients undergoing AF ablation, CNBP monitoring with the ClearSight device showed acceptable agreement with IBP monitoring. Larger studies are needed to confirm the potential clinical implications of continuous noninvasive BP monitoring during AF ablation.

High-power short-duration (HPSD) ablation is an increasingly used ablation strategy for pulmonary vein isolation (PVI) procedures, but Lesion Index (LSI)-guided HPSD radiofrequency (RF) applications have not been described in this clinical setting. We evaluated the procedural efficiency and safety of an LSI-guided HPSD strategy for atrial fibrillation (AF) ablation. Paroxysmal and persistent AF patients scheduled for AF ablation were prospectively enrolled and divided into two groups, according to the ablation power used (≥45 W for the LSI-HP Group and ≤40 W for the LSI-LP group). All patients underwent only PVI LSI-guided ablation (5.5 to 6 anteriorly; 5 to 5.5 superiorly, 4.5 to 5 posteriorly) with a point-by-point strategy and an inter-lesion distance <6 mm. Forty-six patients with AF (25 in the LSI-HP Group vs 21 in the LSI-LP Group)—59% paroxysmal, 78% male, with low-intermediate CHA₂DS₂-Vasc scores (2 [1–3]), a preserved ejection fraction (65 ± 6%) and a mean left atrial index volume of 39 ± 13 mL/m² were prospectively enrolled. Baseline clinical characteristics were comparable between groups. PVI was successful in all patients. The RF time (29 (23–37) vs. 49 (41–53) min, p < 0.001), total procedure time (131 (126–145) vs. 155 (139–203) min, p = 0.007) and fluoroscopy time (12 (10–18) vs. 21 (16–26) min, p = 0.001) were significantly lower in the LSI-HP Group. No complications or steam pops were seen in either group. LSI-HP AF ablation significantly improved procedural efficiency—reducing ablation time, total procedural duration, and fluoroscopy use, while maintaining a comparable safety profile to lower-power procedures.